Tissue tracking of segmental strain as a predictor of provoked dynamic left ventricular outflow tract obstruction

Background: Left ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). Some patients develop LVOTO provoked by physical exertion, and hence termed dynamic LVOTO (DLVOTO). However, its precise prevalence and mechanism are still unclear. Aim: Two-dimensional speckle tracking echocardiography (2D STE) seems to be helpful for the detection of early LV structural abnormalities. This study aimed to examine the possible role of segmental as well as global longitudinal strain in identifying DLVOTO non-HCM patients as detected by dobutamine stress echocardiography (DSE). Methods and results: Two hundred and fifty patients without structural heart disease had undergone conventional transthoracic echocardiography, 2D STE, and DSE. All patients with non-ischemic evidence were divided into two groups according to the DSE results; DLVOTO (þ) and DLVOTO (). Among 250 patients, 50 patients (36%) had shown DLVOTO after DSE (15 males, 35 females; mean age 55±7years). They were compared with 90 non -LVOTO obstruction patients (43 males, 47 females; mean age 57±6years). Based on multivariate logistic regression analysis, the independent predictors of provoked DLVOTO during DSE were resting basal septal longitudinal strain BS-LS average (p < 0.001), resting LA reservoir strain (p < 0.001), and systolic LVOT diameter (p ¼ 0.03). Resting BS-LS average with cut-off - 17.5% was recognized as a critical indicator of DLVOTO, with sensitivity 78%, and specificity 95% (better than systolic LVOT diameter of sensitivity 76%, and specificity 15% and resting LA reservoir strain which showed poor AUC at ROC curve 0.007). Conclusion: We demonstrate that provoked LVOTO during DSE in non HCM symptomatic patients is directly correlated to resting regional LS, where the increased BS-LS of 17.5% was a key determinant of LVOT gradient provocation. Assessment of baseline BS-LS average might be a bedside simple tool for detection of patients with DLVOTO not able to do DSE.

Comparative anthelmintic efficacy of Arundo donax, Areca catechu, and Ferula assa-foetida against Haemonchus contortus / Eficácia anthelmíntica comparativa de Arundo donax, Areca catechu e Ferula assa-foetida contra Haemonchus contortus

Abstract In the present study, anthelmintic activities of Arundo (A.) donax L., Areca (Ar.) catechu L., and Ferula (F.) assa-foetida L. were determined. Leaves of A. donax L., latex of F. assa-foetida L. and seeds of Ar. catechu L. in different solvent fractions were subjected to in vitro (egg hatch assay; EHA, and adult motility assay; AMA) and in vivo (faecal egg count reduction test; FECRT) tests of anthelmintic activity using Haemonchus contortus model. In the AMA, crude aqueous methanol extracts (CAME) and ethyl acetate fractions of F. assa-foetida at 10 hr post-treatment showed maximum mortality of H. contortus at 12.5-50 mg mL-1. In the EHA, CAME of F. assa-foetida was identified as a potent ovicide based on its low LC50 (16.9 µg mL-1), followed in order by Ar. catechu and A. donax. Results from the FECRT also showed the extract of F. assa-foetida L. to be more effective than those of Ar. catechu L. and A. donax L., against the gastrointestinal parasitic nematodes. Chloroform and ethyl acetate fractions showed better anthelmintic activities against the adult worms in vitro, while CAME of these plants were better than their crude powders in vivo. It is recommended to document and investigate indigenous knowledge of possible medicinal plants to plan scientific trials that may justify their endorsement.

Resumo No presente estudo, as atividades anti-helmínticas de Arundo (A.) donax L., Areca (Ar.) Catechu L. e Ferula (F.) assa-foetida L. foram determinadas. Folhas de A. donax L., látex de F. assa-foetida L. e sementes de Ar. catechu L. em diferentes frações de solvente foram submetidos a testes in vitro (teste de eclosão de ovos, EHA e ensaio de motilidade em adultos, AMA); e in vivo (teste de redução da contagem de ovos fecais, FECRT) de atividade anti-helmíntica, usando-se Haemonchus contortus. Na AMA, extratos aquosos brutos de metanol (CAME) e frações de acetato de etila de F. assa-foetida. Dez horas pós-tratamento, apresentaram mortalidade máxima de H. contortus em 12,5-50 mg mL-1. No EHA, CAME de F. assa-foetida foi identificado como um ovicida potente baseado em seu baixo LC50 (16,9 µg mL-1), seguido em ordem por Ar. catechu e A. donax. Os resultados do FECRT também mostraram que o extrato de F. assa-foetida L. é mais eficaz do que o de Ar. catechu L. e A. donax L., contra nematoides parasitas gastrointestinais. As frações clorofórmio e acetato de etila mostraram melhores atividades anti-helmínticas contra vermes adultos in vitro, enquanto o CAME dessas plantas foi melhor do que o pó bruto in vivo. Recomenda-se documentar e investigar o conhecimento indígena de possíveis plantas medicinais para planejar ensaios científicos que possam justificar seu endosso.

Echinostoma miyagawai Ishii, 1932 (Echinostomatidae) from Ducks in Aceh Province, Indonesia with Special Reference to Its Synonymy with Echinostoma robustum Yamaguti, 1935

Adult echinostomes having 37 collar spines collected from the intestine of Pitalah ducks in Aceh Province, Indonesia in 2018 were morphologically and molecularly determined to be Echinostoma miyagawai Ishii, 1932 (Digenea: Echinostomatidae). Among 20 ducks examined, 7 (35.0%) were found to be infected with this echinostome, and the number of flukes collected was 48 in total with average 6.9 (1-17) worms per duck. The adult flukes were 7.2 (6.1-8.5) mm in length and 1.2 (1.0-1.4) mm in width (pre-ovarian or testicular level) and characterized by having a head collar armed with 37 collar spines (dorsal spines arranged in 2 alternating rows), including 5 end group spines, and variable morphology of the testes, irregularly or deeply lobed (3-5 lobes) at times with horizontal extension. The eggs within the worm uterus were 93 (79-105) µm long and 62 (56-70) µm wide. These morphological features were consistent with both E. miyagawai and Echinostoma robustum, for which synonymy to each other has been raised. Sequencing of 2 mitochondrial genes, cox1 and nad1, revealed high homology with E. miyagawai (98.6-100% for cox1 and 99.0-99.8% for nad1) and also with E. robustum (99.3-99.8% for nad1) deposited in GenBank. We accepted the synonymy between the 2 species and diagnosed our flukes as E. miyagawai (syn. E. robustum) with redescription of its morphology. Further studies are required to determine the biological characteristics of E. miyagawai in Aceh Province, Indonesia, including the intermediate host and larval stage information.

Association between Parental Smoking and Pneumonia among Children Less Than 5 Years of Age

Introduction: Pneumonia continues to be the biggest killerworldwide of children under five years of age. Although theimplementation of safe, effective and affordable interventionshas reduced pneumonia.Objective: The objective of this study was to find associationbetween parental smoking and pneumonia in children under 5years of age presenting to tertiary care hospitals in Peshawarcity, Pakistan.Methodology: It was Unmatched Case Control Study with aratio of 1:1. Cases were children less than five years of agepresenting to four major tertiary care hospitals with Pneumoniainfection. Controls were selected from same hospital withmedical condition other than respiratory infection.Results: Among the total sample of 248 children, 67 (27%) ofthe children’s parents were smokers while 181 (83%) were notsmoking. Pneumonia infections were twice likely to developamong those children who were exposed to parental smokingat home with an odd ratio of 2.02 (95% C: 1.14-3.60)Conclusion: Children exposed to second hand smoking are athigh risk of developing respiratory problems like asthma later inlife. More effective policies and strategies are required to limitthe second hand smoking exposure at homes.

Effects of single-dose, low-level laser therapy on pain associated with the initial stage of fixed orthodontic treatment: A randomized clinical trial / 대한치과교정학회지

OBJECTIVE: The aim of this study was to assess the analgesic effect of a single application of low-level laser therapy (LLLT) on spontaneous pain and pain on chewing after placement of initial archwires. METHODS: Forty-two patients (26 women, 16 men) were randomly recruited for this split-mouth randomized clinical trial. Each patient received super-elastic nickel-titanium (NiTi) initial archwires (0.012, 0.014, 0.016, and 0.018-inch [in]) in the maxilla for leveling and alignment for an interval of 4 weeks between archwires. One side of the mouth was randomly designated as experimental, while the other side served as placebo. After insertion of each archwire, the experimental side was irradiated with a diode laser for 3 seconds each on 5 points facially and palatally per tooth, from the central incisor to first molar. On the placebo side, the laser device was held the same way but without laser application. A numerical rating scale was used to assess the intensity of spontaneous and masticatory pain for the following 7 days. The Mann-Whitney U test was used to compare pain scores between sides. RESULTS: Patients in the LLLT group exhibited significantly lower mean scores for spontaneous pain after insertion of the initial two archwires (0.012-in and 0.014-in NiTi; p < 0.05), while there was no significant difference for 0.016-in and 0.018-in wires between the LLLT and placebo groups. LLLT significantly reduced chewing pain scores (p < 0.05) for all archwires. CONCLUSIONS: A single dose of LLLT considerably lessened postoperative pain accompanying the placement of super-elastic NiTi wires for initial alignment and leveling.

Effect of Caffeine and Vitamin D3 on Proliferative and Hypertrophy zones of Epiphyseal Cartilage of Mice Femur

Objective: To determine the effect of caffeine and vitamin D3 on the height of proliferative and hypertrophy zones of epiphyseal cartilage of developing femur of BALB/c mice

Study Design: Laboratory based randomized control trial

Place and Duration of Study: The study was conducted at anatomy department, Army Medical College [AMC], Rawalpindi, in collaboration with National Institute of Health [NIH], Islamabad from Oct 2014 to Oct 2015

Material and Methods: A total of thirty [30] BALB/c mice [15 male, 15 female], three weeks old and weighing 12-14 g, were taken and divided in to three equal groups of 10 mice each [5 male, 5 female]. The control group G1 was given normal diet with water ad libitum. In addition to the same diet, animals in experimental group G2 were given 10 mg of caffeine per 100 g body weight once a day on alternate days through oral gav age for 60 days. All animals of group G3 for 60 days were given caffeine 10mg/100gm body weight on alternate day and vitamin D3 0.1?g per day by oral gav age. At completion of the experiment, effect of caffeine and vitamin D3 on the height of proliferative and hypertrophy zones of epiphyseal cartilage of mice's femur was analyzed

Results: The mean +/- SD of height of proliferative and hypertrophy zones of control group G1 animals was found to be 31.5 +/- 4.1?m and 43 +/- 2.6?m, respectively. The mean +/- SD of height of proliferative and hypertrophy zones of experimental group G2 animals was observed as 59 +/- 3.2?m and 72.5 +/- 7.2?m, respectively. The mean +/- SD of height of proliferative and hypertrophy zones of experimental group G3 animals was measured as 46 +/- 4.6?m and 54 +/- 4.6?m, respectively

Conclusion: Caffeine intake altered the height of proliferative and hypertrophy zones of the epiphyseal cartilage of developing femur; however treatment with vitamin D3 ameliorated this effect

Synthesis, characterization and biological evaluation of some 5-methylpyrazine carbohydrazide based hydrazones

Pyrazine carbohydrazide based hydrazones were synthesized starting from 5-methylpyrazine-2-carboxylic acid. The acid was first converted to its methyl ester, which on further treatment with hydrazine hydrate transformed to carbohydrazide. The carbohydrazide was treated with differently substituted aromatic carbonyl compounds giving hydrazones. Characterization of the synthesized compounds was carried out using modern spectroscopic techniques and unambiguously confirmed through X-ray crystallographic studies of compound 3d. The purity of the compounds was verified using elemental analysis. The target molecules were evaluated for urease inhibition, antioxidant and antimicrobial activity

Assessment of periapical root resorption after six months of fixed orthodontic treatment

Objective: the objective of the study was to compare the frequency and amount of root resorption after 6 months of fixed orthodontic treatment in crowding and non-crowding orthodontic patients

Methods: this cross sectional study conducted at the Department of Orthodontics, Alvi Dental Hospital, Karachi. The six month study was conducted from June - December 2008. Sample consists of 60 patients of two groups. Group A comprises of 30 patients of crowding in maxillary anterior teeth and Group B consisted of 30 patients of non crowding cases of maxillary anterior teeth. The data was collected through non probability purposive sampling. In preorthodontic phase [stage I], the apical root resorption was measured as a difference between length of tooth at pretreatment [T1] as compare to stage II [Postorthodontic stage] i.e. length of root six months after the orthodontic treatment [T2]. Subjective scoring of resorption was done from 0-4 with the help of apical root resorption index. Finally the root resorption was compared in between two groups i.e. crowding and non-crowding and data was recorded in a predesigned questionnaire

Results: in crowding group we found 27 [90%] cases with apical root resorption of less than 2mm as compared to non-crowding group, which had 21 [70%] cases. When compared the length of the tooth in stage II the average length was significantly higher in non-crowding group as compared to crowding [p<0.05]. In crowding group we found statistically significant difference in mean decrease length of tooth [mm] at T2 i.e after 6 months compared to mean tooth length [mm] [p<0.05] at T1. We estimated mean decrease of difference in length of T1 and T2 in crowding group compared with noncrowding group [p< 0.05]

Conclusion: there is significant difference [p<0.05] in mean length of tooth root in crowding and noncrowding patients after six months of orthodontic treatment

Effect of chewing gum on pain in fixed orthodontic treatment

Objective: To assess the intensity of orthodontic pain with and without the use of chewing gum during fixed orthodontic treatment in two groups of patients presenting at the Orthodontic Department of Liaquat College of Medicine and Dentistry, Karachi

Methods: The study was conducted at the Orthodontic Department of Liaquat College of Medicine and Dentistry, Karachi, Pakistan. The sample population of this study was thirty adult patients who were planned to initiate fixed orthodontic appliance treatment. In this study, a parallel group clinical trial was conducted with two analogous groups, one was asked to chew gum following orthodontic bracket placement and second was asked not to chew gum. Up until the working wire was placed, the patients filled a questionnaire of Impact of Fixed Appliances after 24hrs and 1week. In order to analyze the intensity of pain, a visual analogue scale [VAS] was used

Results: At the initial 24hrs, among both chewing gum and non chewing gum groups, the difference in median Total Impact Score was 2, which means there was considerable difference [p=0.034; Mann-Whitney U test]

Whereas, the median difference of VAS among the two groups at 24 hours was also 2, also depicting there was considerable difference [p=0.03; Mann-Whitney U test]. However, after 1 week, there was no significant difference in both groups

Conclusion: Both the pain and impact of fixed orthodontic appliance was reduced by using chewing gum

Post operative nausea and vomiting [ponv]: comparison of timing of administration of antiemetics in prolong surgeries

The objective of this study was to compare the timing of administration of Ondansetron and Dexamethasone in terms of prevention of postoperative nausea and vomiting when given at induction verses thirty minutes before the end of prolong surgeries. Randomized control trial. The study was conducted in Main Operation Theatre of Combined Military Hospital Rawalpindi over a period of six months from 17 Apr 2009 to 16 Oct 2009. Cases were selected from OPDs, emergency and also by referral. Total 120 patients were included in this study [60 patients in each group] Group A patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams intravenous at induction and group B patients received Ondansetron 4 milligrams and Dexamethasone 8 milligrams thirty minutes before reversal of neuromuscular blockade at the end of surgery. Mean age was observed 41.7 +/- 3.7 and 39.9 +/- 1.9 in group-A and B, respectively. Comparison of pre-induction and 30 minutes before end of surgery at 0-6 hours reveal nausea and vomiting in 11 [18.3%] in group-A and in 3 [5.0%] patients of group-B. Results were statistically significant [p=0.022]. At 7-12 hours results were also statistically significant when comparison was made between group-A and B [p=0.051], while at 13-24 hours difference between two groups was statistically non-significant [p=0.314]. It is therefore established that administering a combination of Inj. Ondansetron 4mg with Inj. Dexamethasone 8mg, was more efficacious in reducing post-operative nausea and vomiting at 0-6 hours when administered 30 minutes before the completion of surgery

Ethnobotanical survey; common medicinal plants used by people of Cholistan desert

Medicinal plants are used for the production of different medicines and also for the treatment of different diseases

Study Design: Study is based on a survey

Setting: Traditional medicinal uses of common medicinal plants of Cholistan desert

Objectives: The present investigation is aimed to conserve and create awareness about the ethno medicinal value of the plants and their uses to draw the attention of pharmacologists, phytochemists and pharmaceuticals

Methods: In the study area a total of 33 plant genuses belonging to 21 families are reported. In current study the medicinal plants and their indigenous medicinal uses are only presented by interviewing the local informants and Hakims. The information gained by these sources is presented here. For every plant basic information like family of plant genus, botanical name, local name, plant origin, abundance, status, plant form, part used and medicinal importance are given

Results: Field observations showed that deforestation, over grazing, agricultural expansion and unscientific collection, processing and preservation of natural vegetation are the major threats in the investigated area

Conclusion: There is dire need to conserve plant resources of Cholistan desert

Accuracy of the upper lip bite test; modified Mallampati classification in predicting difficult endotracheal intubation

To compare the accuracy of Upper lip bite test with modified Mallampati classification for predicting the difficult laryngoscopic intubation. Cross sectional Study. The study was carried out at Department of Anaesthesiology, Intensive Care and Pain management, Combined Military hospital, Rawalpindi from September 2008 to August 2009. Four hundred patients undergoing elective surgery meeting the inclusion/exclusion criteria were enrolled after written informed consent. The airways of the patients were evaluated by using the modified Mallampati classification [MMP] and the Upper lip bite test [ULBT]. MMP class 3 or 4 and ULBT class 3 were considered as indicators of difficult intubation. The laryngeal view was graded by Cormack and Lehane classification [Gold standard]. Grade 1 or 2 was considered to represent easy intubation and grade 3 or 4 to represent difficult intubation. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated for both the tests separately by using the 2x2 table. ULBT had a higher accuracy of 94%, specificity of 99.2% and positive predictive value 70% compared to MMP accuracy of 82.7%, specificity of 84.4% and positive predictive value of 22.7%. The diagnostic accuracy of the Upper lip bite test was more than the modified Mallampati classification. We suggest that it be compared with the other prevailing tests as well which are often used to assess difficult intubations

experience of laparoscopic sleeve gastrectomy in obese, morbidly obese, and super morbid obese patients

To report experience with laparoscopic sleeve gastrectomy [LSG] in obese, morbidly obese, and super morbid obese patients, and to evaluate comparative efficacy of LSG among these patient groups. A total of 147 patients underwent LSG between March 2008 and December 2011 at the Department of Surgery, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia. Patients were grouped according to the preoperative body mass index [BMI] into obese [35-39.9 kg/m[2]], morbidly obese [40-49.9 kg/m[2]], and super morbid obese [>50 kg/m[2]]. Patients who did not have a regular follow-up [n=38] were excluded, and 108 patients were included in this prospective study. The mean total weight loss [TWL] among the super morbid obese group [41.31 +/- 21.23 kg] was statistically significantly greater compared to the obese group [24.31 +/- 13.00 kg, p=0.009] and morbidly obese group [26.81 +/- 15.56 kg, p=0.001]. The mean percentage excess weight loss [EWL] was clinically significant among obese [57.8%], morbidly obese [42.5%], and super morbid obese patients [45.7%], however, it was not statistically significant between the groups [F[2,105] =2.132, p=0.124]. There was no mortality; however, 6 major complications occurred including intra-abdominal collection with suspected leak, staple line bleeding, bowel ischemia, and inferior vena cava injury. Laparoscopic sleeve gastrectomy resulted in satisfactory and effective EWL in all 3 groups of obesity patients at 30-months follow-up

Intravenous regional anesthesia [bier's block]; to compare the analgesic effects of combination of 0.5% lidocaine plus ketrolac in intravenous regional anesthesia technique with those of lidocaine 0.5% alone to prevent post operative pain

To compare the analgesic effects of combination of 0.5% Lidocaine plus Ketorolac in intravenous regional anaesthesia technique with those of Lidocaine [0.5%] alone to prevent post operative pain after intravenous regional anaesthesia [Biers block]. Randomized Control Trial. The study was carried out at Department of Anaesthesiology, Intensive Care and pain management, Combined Military hospital, Rawalpindi from July 2008 to February 2009. The study was conducted after complete evaluation of risk / benefit ratio to the patients. On the basis of random number method the patients were divided into two equal groups [group A and group B]. The number of patients in each group was 75. Group A was assigned Lidocaine in a dose of 200mg 40ml of 0.5% solution and group B was assigned injection Ketorolac 30mg added to Lidocaine in a dose of 200mg 40ml of 0.5% solution. The patients were kept in post anaesthesia care unit for two hours and pain intensity was measured by visual analogue scale[VAS] on 15,30 minutes,1hour, 1.5 and at 2 hours after the cuff deflation. The analgesic efficacy recorded on the basis of visual analog scale of two groups, was compared using student's t - test. p value of less than 0.05 was considered statistically significant. In group A 33 males and 42 females were enrolled for the study while in group B there were 38 males and 37 females. The mean age of the patients in group A was 34.31 +/- 6.03 years while in group B was 32.99 +/- 6.08 years. Patients were also classified according to ASA classification in which 87 patients were classified as ASA - I and 63 patients as ASA - II. Group B which received Ketorolac in addition to Lidocaine for Bier's block had low visual analogue scores as compared to group A which received only Lidocaine for Bier's block. P values obtained after the comparison of the mean VAS of two groups at 15 minutes, 30 minutes, 1 hour, 1.5 hours and 2 hours were all less than 0.05 [0.002 for 15 minutes, 0.004 for 30 minutes, 0.001 for 1 hour, 0.004 for 1.5 hours and 0.001 for 2 hours]. Ketorolac improves the postoperative analgesia markedly when used with Lidocaine in intravenous regional anaesthesia

Oxytocin IV bolus vs infusion; haemodynamic effects in women undergoing caesarean section

Obstetric texts advocate the use of oxytocin, either intramuscularly or as a dilute infusion, but warn against the use of intravenous bolus oxytocin, fearing significant maternal hemodynamic consequences. To compare the hemodynamic effects of oxytocin given intravenous bolus versus infusion form. Randomized clinical trial. Study was conducted in main operation theatre and OPD of Combined Military Hospital, Rawalpindi. Study was carried out over a period of six months from 24-03-2009 to 23-09-2009. Total 138 patients were included in this study. Patients were divided into two groups [Group-A received oxytocin as bolus of 5 iu given as quickly as possible [approximately over 1 s] and in group-B 5 iu diluted to 20ml normal saline given over 5 minute using an infusion pump]. Each group comprised of 69 patients. Mean age of the patients in group-A was 27.3 +/- 1.8 and in group-B, 26.9 +/- 1.7. Heart rate [beast/min] effect of oxytocin given intravenous bolus vs infusion showed statistically significant difference from 1 minute to 15 minute [P<0.001]. Similarly mean arterial pressure [MAP] rate [beast/min] effect of oxytocin given intravenous bolus vs infusion also showed statistically significant difference from 1 minute to 15 minute [P<0.001]. In conclusion, we found that at elective Caesarean section, 5 iu of i.v. oxytocin results in less haemodynamic change than 5 iu diluted to 20ml normal saline given over 5 min using as an infusion pump results in less haemodynamic change than 5 iu of oxytocin given as i.v. bolus

Infant mortality and its causes in three different districts of Punjab, Pakistan

Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. This study was conducted to estimate the Infant Mortality Rate [IMR], reporting percentage and to identify the risk factors for infant mortality in Punjab, Pakistan. Retrospective Study. This study was conducted in the Directorate General, Health Services Punjab, Lahore from 01-07-2007 to 30-06-2008. Community-based cross-sectional survey was conducted during July to September 2009. Interviews of female family heads were conducted by the trained researchers. Deaths of 786 infants were reported in three districts, verbal autopsy of all cases was done to find out the causes of deaths during infancy. World Bank [2010] reported IMR of Pakistan 71/1000 live birth [estimated infant's deaths 9811], which is very high from this study [6/1000 live birth]. Major Causes of infant mortality were found malnutrition 194[24.6%], Acute Respiratory Infections [ARI] 188[23.9%], and Diarrheal Diseases 161[20.4%]. Mortality due to said diseases can be reduced by improving childbearing and childrearing practices, equitable distribution of good standard health care facilities, safe drinking water and individual attention

Extensive retroperitoneal hematoma in blunt trauma

To report our experience of managing extensive retroperitoneal hematoma [RH] in patients with blunt trauma and to determine any associated factors affecting causation and mortality. In this retrospective observational study, patients diagnosed with extensive RH following blunt trauma admitted to King Saud Medical Complex, Riyadh, Kingdom of Saudi Arabia between January 2004 and December 2009 were included. Patient data were explored for injury severity score [ISS], data were explored for injury severity score [ISS], associated injuries, location of hematoma, amount of blood transfusions, coagulation profile, operative management, hospital stay, and mortality. The outcomes in surviving and non-surviving patients were compared. Out of 290 patients presenting with RH, extensive RH was found in 46 patients [15.8%]. The overall mortality was 32.6%. The pelvis was the most frequent location of RH in combination with lateral and central zones [65.2%]. The lower extremity and pelvic fractures were the most common injury. Associated intra-peritoneal injuries were present in 39.1% patients. An exploratory laparotomy was performed in 58.7% patients [n=27]. A high ISS [55.95 versus 35.5, p<0.0001], abnormal coagulation profile [odds ratio [OR] 7.8, 95% confidence interval [CI] 1.974-30.932, p=0.005], and associated chest injuries [OR 5.94, 95% CI 1.528-23.19, p=0.014] were independent factors associated with mortality. Multiple musculoskeletal injuries in addition to intra-abdominal injuries and abnormal coagulation are major factors associated with the presence of extensive RH. High ISS, abnormal coagulation, and associated chest injuries are independent factors associated with mortality

Pneumomediastinum, pneumothorax, and subcutaneous emphysema due to duodenal ulcer

The presence of pneumothorax, pneumomediastinum, or cervical subcutaneous emphysema due to perforated duodenal ulcer is a rare presentation. We report a 23-year man who showed bilateral cervical subcutaneous emphysema, pneumomediastinum, and pneumothorax with no respiratory abnormality. He was found to have active duodenal ulcers, but no detectable pneumoperitoneum or duodenal leal. A sealed perforation from the duodenal ulcers was suspected, and he fully improved after conservative management

Impact of comorbidity on outcome among acute non-traumatic surgical patients. Evaluation of Charlson comorbidity index

To determine the prevalence of comorbid conditions among acute non-traumatic general surgery patients. To assess the impact of comorbidity on outcomes and evaluate the effectiveness of using Charlson comorbidity index [CCI] in these patients. All acute non-traumatic general surgery patients admitted to King Saud Medical Complex, Riyadh, Saudi Arabia, between January 1, 2007 and December 31, 2007 were included [n=1296]. Patient data were explored to record comorbidity, and the CCI score calculated. The length of hospital stay, post-operative complications and mortality were recorded as outcome measures. The outcomes in patients with comorbid conditions were compared with patients without comorbid conditions. We found one or more comorbid conditions in 31.9% [n=414] patients. The CCI score ranged from 1-8. All 3 outcome measures were recorded significantly higher in patients with comorbidity compared to patients with no comorbid condition; length of stay, 17.3 versus 10.6 days [p < 0.0001], post-operative complications 46.3% versus 31% [p < 0.0001], mortality 7.7% versus 4.4% [p < 0.0001]. Severe comorbidity as indicated by higher CCI score significantly correlated with length of stay, r=0.30 [p < 0.0001] and mortality, r=0.2645 [p < 0.0001]. Overall risk of mortality was 1.81 times higher with comorbidity [odds ratio 1.81, 95% confidence interval 1.087-3.012, p=0.0182]. Comorbidity caused increased hospital stay, post-operative complications, and mortality among acute non-traumatic general surgery patients. The CCI is a reliable comorbidity index, which can help in managing risks in surgical patients